Healthcare Provider Details

I. General information

NPI: 1497799191
Provider Name (Legal Business Name): EDWARD JONATHAN PARKER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 HARRISON PKWY SUITE 200
SUNRISE FL
33323-2853
US

IV. Provider business mailing address

PO BOX 817737
HOLLYWOOD FL
33081-1737
US

V. Phone/Fax

Practice location:
  • Phone: 800-437-2672
  • Fax:
Mailing address:
  • Phone: 800-437-2672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOS9739
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: